Attachment 4 - Past Performance Questionnaire.pdf

Controlled Unclassified Information (CUI) When completed, this document is Source Selection Information IAW FAR 2.101 and 3.104.

RFQ FA500023Q0005

Attachment 4 Past Performance Questionnaire

Controlled Unclassified Information (CUI) Page 1 of 4

SUBJECT: Request for Past Performance Evaluation

TO: ________________________

__________________________is currently participating as a respondent to the Government’s Request for solicitation No. FA500023Q0005 for Furnishings Management Section services at Joint Base Elmendorf-Richardson, Alaska. We anticipate awarding a firm-fixed-price contract.

The Government will be selecting Contractors for this project based on selection factors. One of the key factors in the Government’s final decision is past performance. To assist the Government in its assessment of Contractor past performance, we are required to identify previous projects and clients who are familiar with our past work. For the purposes of this questionnaire, past work is defined as contracts performed and/or being performing for any customer within the last five (5) years from the issuance day of the solicitation (21 December 2022).

As one of our customers for past contracting work on __________________________________, we are requesting that you complete the attached questionnaire regarding our past performance. This letter also authorizes you to discuss our past performance with the Government and to release information regarding our past performance to the Government.

Your prompt attention in completing the attached questionnaire will ensure we receive full consideration in this competition. Please return the completed form to the Government point of contacts (POCs) identified below, response is required no later than 12:00 P.M. Alaska Standard Time (AKST) on Wednesday, 21 December 2022.

Government POCs Sheng Morris – sheng.morris@us.af.mil Sean Leigh – sean.leigh.1@us.af.mil

Thank you for your assistance.

(Signature and title of individual with the authority to sign for and legally bind the Contractor)

Attachment : Past Performance Questionnaire

RFQ FA500023Q0005

Attachment 4 Past Performance Questionnaire

Controlled Unclassified Information (CUI) Page 2 of 4

Section 1: Contract Identification

A. Contractor (Company/Division):

B. Contractor Cage Code:

C. Contract Number:

D. Contract Type (e.g., FFP, FPIF, CPIF, CPFF, etc.):

E. Program Title:

F. Brief Description of Services Performed:

G. Period of Performance:

H. Contract Dollar Value:

I. Contractor’s Role: ☐ Prime Contractor ☐ Subcontractor

Section 2: Customer or Agency Identification

A. Customer or agency name:

B. Customer or agency description (if applicable):

C. Geographic description of work performed under this contract (i.e., local, nationwide, worldwide, other Commands):

Section 3: Respondent Identification

A. Respondent’s name:

B. Respondent’s title:

C. Respondent’s phone/fax number/e-mail address:

D. Length of time (number of years/months) respondent worked on subject contract and description of responsibility/position/role:

E. Other suggested points of contact:

RFQ FA500023Q0005

Attachment 4 Past Performance Questionnaire

Controlled Unclassified Information (CUI) Page 3 of 4

Section 4: Performance Information

Scope of Work Yes No

1. Does your contract involve receiving and issuing an average of 1,200 or more furniture and/or appliance deliveries annually?

2. Does your contract have an inventory of approximately 43,500 or more items?

3. Does your contract involve the use of inventory tracking software for inventory management and control?

4. Does your contract involve repairing an average of 275 or more appliances?

5. Does your contract involve repairing an average of 185 or more furnishings annually?

In the table below, indicate your rating for the contractor’s performance by placing an “X” in the appropriate block to the right of each question. The performance rating scale is defined as follows:

RATING DEFINITION

O Outstanding During the contract period, contractor performance is meeting (or did meet) all contract requirements and is exceeding (or did exceed) some, if not all contract requirements. For any problems encountered, contractor took effective corrective action.

S Satisfactory During the contract period, contractor performance is meeting (or did meet) contract requirements. For any problems encountered, contractor took effective corrective action.

U Unacceptable During the contract period, contractor performance is not meeting (or did not meet) contract requirements. For any problems encountered, corrective action appeared only marginally, not effective, or not fully implemented. Customer involvement was required.

N/A Not Applicable Used if the rating(s) are not going to be applied to a particular area for evaluation.

Contractor Performance: O S U N/A

1. How would you rate the Contractor’s ability to maintain standards outlined in your Performance Work Statement, Statement of Work, or equivalent requirements documents?

2. How would you rate the Contractor’s ability to accurately track and maintain inventory?

3. How would you rate the Contractor’s ability to pick-up and deliver furniture and/or appliances in a timely manner?

4. How would you rate the Contractor’s quality of furniture and appliance repair?

RFQ FA500023Q0005

Attachment 4 Past Performance Questionnaire

Controlled Unclassified Information (CUI) Page 4 of 4

Contractor Performance: O S U N/A

5. How would you rate the Contractor’s customer service?

[click and pick the date]

Respondent’s Signature Date

Thank you for your prompt response and assistance!

Please return this completed questionnaire to:

Sheng Morris – sheng.morris@us.af.mil Sean Leigh – sean.leigh.1@us.af.mil